The National Cancer Institute's Radiation Oncology Sciences Program (ROSP) is actively sponsoring a clinical outreach program, known as the Partnerships in Science(TM) Program. In addition, the NCI Radiation Oncology Branch (ROB), which is a component of ROSP, is continuing the development of a specialized radiotherapy treatment planning system, to suit their protocol requirements. The NCI ROB also supports a residency training program jointly with the Walter Reed Army Medical Center (WRAMC) and the National Naval Medical Center (NNMC). Finally, the NCI is a participant in the NCI All Ireland Cancer Consortium which combines the cancer treatment capabilities of Bethesda, Belfast, and Dublin in a five-year relationship aimed at a multilevel attack on cancer in Ireland. For these four reasons, the NCI and ROSP are interested in high-speed medical image communication, and telemedicine systems. The CIT and the NCI are, therefore, collaborating in the development and implementation of advanced telemedicine technologies, in general, and the TELESYNERGY(R) System, in particular. The TELESYNERGY(R) Medical Consultation WorkStation (MCWS) has been developed by CBEL, and was initially deployed in the NCI ROB and the CIT environments on the NIH campus. The MCWS, which is based upon Asynchronous Transfer Mode (ATM) network architecture, allows real-time multimedia conferencing between distributed sites, and the systems includes high-resolution electronic view boxes for the display of CT, MRI or chest film images. Also included is a high-resolution video link for the presentation of a view of the consultant, the display of video-taped medical images or live presentations, or the display of histopathology images obtained from remote-controlled microscopes. As a component of this project, a prototype high-speed medical image communication network was implemented, based on ATM switch technology, which allows 155 Mbit/sec multi-media communication between users. The MCWS System also allows ATM-Gateway access to remote/distant sites via high-speed ISDN PRI telephone service. The NCI has selected the TELESYNERGY(R) System as the enabling technology for their Partnerships in Science(R) Program, and the first of these partnerships sites to be implemented with the TELESYNERGY(R) System was the Holy Cross Hospital, in Fort Lauderdale, Florida, during the Summer of FY00. A TELESYNERGY(R) System was installed at the WRAMC in April of FY01. A second Partnerships in Science(TM) site, the Schiffler Cancer Center at the Wheeling Hospital, in Wheeling, West Virginia, had a System installation completed during January of FY02. In addition, TELESYNERGY(R) systems were implemented at the Belfast City Hospital in Belfast, N.I., U.K., and at the St. Luke's Hosptial in Dublin, Republic of Ireland, during the summer of FY02. Other MCWS Systems are currently being installed in the redesigned CC 11th floor Telemedicine Clinic, and at the NNMC, during FY03. The development of a portable version of the TELESYNERGY(R) Environment was begun during FY02, in order to be able to provide a temporary high-performance telemedicine solution in response to a medical emergency. This System is being completed during the current Fy and will be finished during FY04. Since September 1999, we have been planning the installation of a TELESYNERGY(R) System within the King Husein Cancer Center (KHCC) in Amman, Jordan, as part of an NCI-Jordan Cancer Consortium. The installation of the TELESYNERGY(R) System has been fully funded by the KHCC during FY03, and the components are being assembled for installation in Jordan during the first quarter of FY04. A new initiative, begun during FY03, is the implementation of a TELESYNERGY(R) System at the Trinity College School of Radiation Therapy in Dublin, Republic of Ireland. These two new installations bring the total number of orignal TELESYNERGY(R) Systems to twelve sites, four of which are interconnected by an ATM connectivity, and eight of which utilize ISDN PRI extentions to reach the NIH-centered ATM environment.